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ELEVATION CERTIFICATE <br />OMB No, 1880-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT: In these spaces, copy the corresponding Information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or R.O. Route and Box No. <br />Policy Number. <br />2019 Roan Drive <br />City state ZIP Code <br />Company NAIC Number <br />Ellensburg Washington 98926 <br />SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) <br />FOR ZONE AO AND ZONE A (WITHOUT BFE) <br />For Zones AO and A (without BFE), complete Items E1—E5, N the Certificate Is Intended to support a LOMA or LOMR-F request, <br />complete Sections A, B,and G. For items E1—E4, use natural grade, if available. Check the measurernent used. In Puerto Rico only, <br />enter meters. <br />El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below <br />the highest adjacent grade (HAG) and the lowest adjacent Wade (LAG). <br />a) 'Top of bottom floor (including basement, <br />crawispace, or enclosure) is ❑ feet ❑ nrs ❑ above or ❑ below the HAG. <br />b) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. <br />E2. For Building Diagrams 84 with parmanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), <br />the next higher floor (elevation C2.b In <br />the diagrams) of the building is _-- . ❑ feet ©meters, ❑ above or ❑ below the HAG. <br />E3. Attached garage (top of aiab) Is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />E4. Top of platform of machinery and/or equipment <br />servicing the building is ❑feet ❑ meters ❑ above or ❑belowthe HAG. <br />E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's <br />floodpkain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this triformat#on in Section G. <br />SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION <br />The prop owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA-lssuad or <br />oommuMty ssued BFE) or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. <br />Property Owner or Owner's Authorized Representative's Name <br />Scott Henson <br />Address City state ZIP Code <br />1224 S Pioneer Way Moan lake Washington 98837 <br />Signature Date Telephone <br />. --). f, (509) 855-5112 <br />Comments <br />❑ Check here I attachments. <br />FEMA Form 0813.MB (12/19) Replaces all previous editions. Form Page 3 of 6 <br />